Blast injuries are caused by explosions which release blast waves, blast winds, ground shock, and heat. Other mechanisms of injury are generated from blasts, including penetrating injuries from shrapnel, radiation, and biological exposure.

Blast waves cause disruption of major blood vessels, rupture of major organs, and lethal cardiac disturbances when the victim is close to the blast. Blast winds and ground shock can cause the collapse of buildings and cause trauma.

Mechanisms of Blast Injuries

1) PRIMARY BLAST INJURIES: When the explosion occurs, a wall of air pressure quickly expands outward in all directions. Anyone close to the explosion will be struck by the pressure wave causing blunt injuries to the inside of the body, especially to hollow organs.

Body system affected:

• lungs,
• GI tract, and
• the middle ear.

Types of injuries include

• blast lung (pulmonary barotrauma),
• tympanic membrane rupture
• Damage to the middle and inner ear
• abdominal hemorrhage and perforation,
• globe (eye) rupture, and
• concussion or TBI without physical signs of head trauma.

2. SECONDARY BLAST INJURIES: Immediately following the primary wave is all the debris from the explosion.

It may be the remainder of the original container, shrapnel, glass or other materials from nearby structures. This debris strikes the victims, causing penetrating injuries. Any body system could be affected. Types of injuries include: penetrating or blunt injuries to any area of the body.

3. TERTIARY BLAST INJURIES: If the force of the explosion is great enough, victims can be thrown to the ground (ground shock) or into other solid objects, causing additional blunt and penetrating injuries.

Any body system can be affected. Types of injuries include: penetrating or blunt injuries to any area of the body. You could also see amputations caused by blast wind.

4. QUARTERNARY BLAST INJURIES: These injuries occur from events that happen during the explosion and include all explosive-related injuries or illnesses not caused by primary, secondary, or tertiary mechanisms.

Any body system can be affected. Types of injuries may include

• burns,
• inhalation injuries,
• crush injuries,
• closed and open head injuries,
• asthma,
• COPD or other breathing problems,
• angina,
• hyperglycemia, and
• hypertension.

MANAGEMENT

Management considerations for blast injuries include multi-system trauma care, immediate transport to the closest appropriate facility, and multi-casualty care.